Active NPI
Jae Young Kim, PHARM. D.
- Pharmacist
- Granada Hills, CA
National Provider Identifier
1235473174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 71953
- Practice address
- 16830 San Fernando Mission Blvd
Granada Hills, CA 91344-4247 - Phone
- (818) 831-5059
- Fax
- (818) 832-6541
- NPI assigned
- Nov 15, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19825 | CO | |
| Pharmacist | 183500000X | 22534 | NC | |
| Pharmacist | 183500000X | 71953 | CA | Primary |
Addresses
Primary practice location
16830 San Fernando Mission Blvd
Granada Hills, CA 91344-4247
Mailing address
16830 San Fernando Mission Blvd
Granada Hills, CA 91344-4247
Phone (818) 831-5059
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71953 | CA | MD | Clinical Social Worker |
| 19825 | CO | MD | Pharmacist |
| 22534 | NC | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vons Companies Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Granada Hills, CA
- NPI 1407892011
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1352937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552521600000",
"number": "1235473174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16830 SAN FERNANDO MISSION BLVD",
"city": "GRANADA HILLS",
"state": "CA",
"postal_code": "913444247",
"telephone_number": "818-831-5059",
"fax_number": "818-832-6541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16830 SAN FERNANDO MISSION BLVD",
"city": "GRANADA HILLS",
"state": "CA",
"postal_code": "913444247",
"telephone_number": "818-831-5059",
"fax_number": "818-832-6541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JAE YOUNG",
"credential": "PHARM. D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-11-15",
"last_updated": "2019-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CO",
"license": "19825",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "22534",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "71953",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granada Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.